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Forty-one percent of massive rotator cuff tears healed after superior capsular reconstruction
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NEW YORK — Despite a high rate of graft failure, results presented here showed improved functional outcomes after superior capsular reconstruction for massive rotator cuff tears.
Robert J. Gillespie, MD, and colleagues compared preoperative and postoperative pain scores and functional outcomes among 33 patients who underwent superior capsular reconstruction with debridement and partial rotator cuff repair.
“We saw an improvement in [simple shoulder test] SST, [American Shoulder and Elbow Surgeons score] ASES [and] VAS and we saw an improvement in [single assessment numeric evaluation] SANE scores, but this was not significant,” Gillespie said in his presentation at the ASES Annual Meeting.
MRIs showed a graft healing rate of 41% and a graft failure rate of 59%, according to Gillespie. He noted significant differences in ASES and VAS scores among patients who had an intact superior capsular reconstruction vs. patients who had a failed superior capsular reconstruction.
“SST and SANE scores showed no significant difference. If they had, it was not a significant difference between these two groups within the cohort,” Gillespie said. – by Casey Tingle
Reference:
Gillespie RJ, et al. Paper 3. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 17-19, 2019; New York.
Disclosure: Gillespie reports he is a paid consultant for Aevumed, DJ Orthopaedics and Shoulder Innovations, and is a paid presenter or speaker for DJ Orthopaedics.
Perspective
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Augustus D. Mazzocca, MS, MD
This was a paper that evaluated postoperative graft integrity after a superior capsular reconstruction (SCR) procedure. MRI imaging was obtained on 17 of 33 shoulders, and they found graft failure in 10 of 17. Patient-reported outcomes were successful and functional improvement was not affected by graft integrity.
One limitation is the lack a histologic analysis of the failures. Two recent case reports have shown cellular histologic changes in second-look specimens. Robert U. Hartzler, MD, MS, and colleagues and Burak Altintas, MD, and colleagues both evaluated the histology of the SCR showing cellular infiltration and neovascularization. Biomechanically, the graft is weaker than intact during the remodeling phase, which is to be expected with all allografts.
Stephen S. Burkhart, MD, and Hartzler were able to demonstrate a reversal of profound pseudoparalysis of the shoulder (active elevation less than 45°) in massive, irreparable rotator cuff tears without arthritis in 90% (N=10) of patients after arthroscopic SCR. Burkart also showed in 2018 similar MRI results with 45% (nine of 20) of the grafts demonstrating complete healing. Forty-six (74.6%) cases were considered a success. Eleven patients (18.6%) underwent a revision procedure, including seven reverse shoulder arthroplasties.
It is interesting that failed grafts and patient outcomes do not correlate with the SCR. The graft can fail and patients still do well. We also see this with rotator cuff repairs. The SCR is an established procedure for patients with the correct indications. These are massive tears without severe arthritic changes and a subscapularis intact or reparable. This leads to pain relief and motion which can delay patients needing a reverse arthroplasty.
We applaud researchers who look at clinical outcomes critically to evaluate how techniques impact their patients. The more we review the past, the more we can see the future.
References:
Altintas B, et al. Arthroscopy. 2019;doi:10.1016/j.arthro.2019.07.006.
Burkhart SS, et al. Arthroscopy. 2019;doi:10.1016/j.arthro.2018.07.023.
Denard PJ, et al. Arthroscopy. 2018;doi:10.1016/j.arthro.2017.08.265.
Hartzler RU, et al. Arthroscopy. 2019;doi:10.1016/j.arthro.2019.06.024.
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